Abstract

Objectives Some patients with chronic low back pain are not eligible to back school with intensive rehabilitation program because of the intensity of their pain. Therefore we assessed the value of an educational program in a rehabilitation program over a week in chronic low back pain with special emphasis on education

Methods Single-centred prospective study conducted at the University Hospital of Rouen, since July 2009. Patients 18 to 75 years with chronic low back pain persisting for at least 6 months and not eligible for back school because of the importance of pain.

The rehabilitation program takes place during a 5-day stay at the hospital in rheumatology. It includes a multi-professional care (rheumatologist, psychologist, nurse, physiotherapist, occupational therapist, dietician and social worker) with during the week initial diagnosis collective and individual workshops with special focus on education and advice along with structured rehabilitation exercises.

Clinical and functional assessment were made on the first (D1) and last day (D5) of the program and then six months later (M6). The data collected consisted of: demographic with occupational status, clinical measures (pain on a 100 numeric scale, finger-floor distance), functional over various questionnaires (HAQ, DALLAS, FABQ) and treatment (analgesics and co-analgesics). At the end of the week patients and caregivers develop goals for six months such as reducing usage of pain treatment, loosing weight, do sports ...

Results 99 patients (50 women, 49 men) were included: mean age 47 (25-74 years), low back pain disease duration ranges from six months to 33 years, median 7 years. 78 patients were reassessed at 6 months and 21 patients were lost to follow up. Using per protocol analysis: a significant decrease in pain scale between first day and fifth day (median 60 vs 40/100, p<10-6), no difference between fifth day and at 6 months reassessment. Finger-floor distance improved significantly from D1 to D5 (median 29 vs 24cm, p=0.0003) and from D5 to M6 (median 24 vs 19 cm, p=0.001). Considering questionnaires, patients showed significant improvement between D1 and M6 in DALLAS back pain questionnaire in 3 of the 4 domains: work/leisure (median 55 vs 45%, p=0.001), anxiety/depression (median 45 vs 35%, p=0.005) and social interest (median 35 vs 30%, p=0.001). At M6 significant proportion of patients had a daily use of TENS (21.8 vs 69.2%, p<10-6). At the end of the program at D5 patients chose a median of 3 goals to achieve during the 6 months before reassessment, at M6 patients had achieved 74% of the goals they had set at the end of the week program.

Conclusions Our study, even though we didn't use a control group, shows that pain and function have improved, as well as the use of TENS. Also with the support of the education and advices given during the program, patients achieved a mean of 74% of the goals that were given. Moreover, the patients were satisfied of the program. For patients with chronic low back pain but not eligible to intensive rehabilitation program because of the intensity of pain, this short multidisciplinary program with a strong educational approach might be of interest.

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